Penile Inversion Vaginoplasty

Penile inversion vaginoplasty requires a minimum stay of one week for proper monitoring of the patient’s progress.

The operation usually lasts three to five hours and is performed under general anaesthesia. Part of the glans is used to form the clitoris, while most of the penile skin is repositioned to form the vaginal walls. The corpora cavernosa and part of the urethra, which are responsible for erection, are removed.

The urethra is shortened and redirected to emerge just above the new vaginal opening. Some of the urethra is used to line the labia minora and vaginal walls, creating a more natural appearance. The spermatic cords are severed, and the testicles are removed. The surrounding scrotal skin is used to form the labia majora and minora.

Once the anatomical space between the bladder and rectum is created, the penile skin is inverted to form the vaginal walls. The depth of the vagina depends on the amount of penile and scrotal skin and the patient’s anatomy. The goal is a depth of at least 15 centimetres. A dressing is applied to keep the skin in place during healing.

The clitoris is reconstructed from the preserved glans, ensuring sensitivity. In most cases, the surgery is completed in one operation, but sometimes aesthetic procedures may be postponed.

Compressive bandages are applied, and the patient will use a bladder catheter for about two weeks.

Who can undergo penile inversion?

Not all trans people seeking vaginoplasty are suitable for penile inversion. To be able to perform a penile inversion surgery, you must have a penis with minimum dimensions (it must measure more than 12 centimeters stretching the skin of the penis and counting from the peno-pubic angle to the tip of the foreskin) and a good quality of the penile skin. In any case, it will always be the surgeon who will assess all the circumstances, as well as the person’s medical history and the suitability of the technique to be used in their case.

Continuing hormonal treatment after surgery

Many people who undergo surgery such as penile inversion surgery are treated with oestrogens and anti-testosterone drugs. Taking estrogen carries a risk of deep vein thrombosis during surgery. For this reason, oestrogens are withdrawn about one month before the operation. As for anti-testosterone drugs such as Androcur or Decapeptyl, experience has shown that withdrawal is not necessary. They can be maintained until the operation. Their total withdrawal will be one or two weeks after the vaginoplasty. IT IS ESSENTIAL THAT YOU MAKE AN APPOINTMENT WITH YOUR ENDOCRINOLOGIST before and after surgery and that you follow their instructions.

Hospital admission requirments for penile inversion surgery

Yes, you will be admitted to IM CLINIC one day before the operation. Throughout that day, you will undergo the relevant monitoring and a bowel cleansing, through the intake of laxatives and antibiotics. This cleansing is essential due to the proximity of the intestine in the creation of the neovagina.

How long will I have to be admitted?

Admission is usually seven days. During post-operative visits, the IM GENDER team will follow a supervision protocol, monitoring vital signs, gradually increasing the patient’s diet, managing pain with a rotation of analgesia, early ambulation and oral antibiotics.

On the last day of admission, the first dilation of the vagina will be performed under a standardized protocol by your doctor, who will explain the care and steps to follow, so that you can perform the recommended dilations at home. The IM GENDER nursing staff will give you a Care Guide and a kit with everything you need so that you can continue with the dilations at home. You will be given a follow-up email as well as subsequent appointments with your surgeon.

When will I be able to go home after the penile inversion?

The bladder catheter is maintained until the tenth day or until periurethral inflammation is minimal, so you will be discharged with this catheter. You will undertake the indicated dilations at home and the treatment prescribed by the analgesia and antibiotic therapy physician.

Once at home, you should contact the endocrinologist supervising your hormone treatment to restart it (after about four weeks) and readjust the dose. You will no longer need to take Androcur or Decapeptyl. It is important that under no circumstances should you readjust your hormone doses yourself as this could cause problems for your health.

What are the postoperative risks of inversion vaginoplasty?

A member of the medical team will tell you how to avoid possible complications and what to do if they should arise. If you have any doubts or anomalies after the operation, you should consult your doctor so that he or she can diagnose and provide a solution. For this purpose, you will have a telephone number available 24 hours a day, as well as a follow-up email address.

Will I be able to have sexual intercourse after penile inversion vaginoplasty?

After MTF vaginoplasty you will have a functional, anatomical vagina, aesthetically similar to that of any other woman. This vagina will be suitable for full sexual activity, free of painful scars, with sufficient sensitivity to receive satisfactory erogenous stimulation during sexual intercourse. It is important that you follow all the recommendations given to you by the medical team, such as vaginal dilations and post-operative visits.

Will I have to go to different medical visits during the penile inversion postoperative period?

It is very important not to skip any of the post-operative visits with a member of the IM Gender team. Only they will be able to assess the progress of your vaginoplasty recovery. As a general rule, once the patient has been discharged from hospital, she will be scheduled for the next visit, which will take place approximately three weeks after discharge from hospital (one month after the operation). The next medical check-ups will be approximately three months, six months and one year after the operation.